Getting Clean, Going Green

Clean and healthy hands depend on clean and healthy soap.

• By Katherine Hinkebein
• May 17, 2010

We hear about the importance of proper hand washing and hygiene almost daily. Recently this happened because of the widespread concern about H1N1 influenza. However, even without concerns about an epidemic, we now know that a proper hand washing program is essential when it comes to reducing and preventing the transmission of disease.

Although hand washing with soap and water has long been considered essential for personal hygiene, it might come as a surprise to learn that it was not until the late 1800s that doctors found a connection between soiled, contaminated hands and the spread of disease. At that time, women in childbirth were dying at an alarming rate in the United States and in Europe. At its worst, as many as one in four women who delivered babies in hospitals died from what was called "childbed fever," which we now know was caused by Streptococcus pyogenes bacteria.

Trying to find the reason for the problem, Vienna's Dr. Ignaz Semmelweis speculated it could be caused by doctors, nurses, and medical students who went from patient to patient -— and even worked on cadavers -— without washing their hands. Semmelweis ordered all hospital staff to wash their hands with a chlorinated solution before examining women in labor. The mortality rate in his maternity wards eventually dropped to less than 1 percent.

Surprisingly, even with this strong evidence that there was a connection between contaminated hands and disease, it was not until a century later, in 1961, that the U.S. Public Health Department started producing films and documentation for health care providers and the general public about the importance of proper hand washing. Among their recommendations as to when hands should be washed are these:

• If hands are visibly soiled
• After using the washroom
• After blowing your nose or sneezing into your hands
• Before and after eating or touching food products, especially raw meat, poultry, or fish
• After handling trash
• After visiting or caring for a sick person
• After touching pets, animals, or animal waste

Is the Soap Clean?
Despite its rocky beginnings, hand washing has become a part of our culture and is taught in schools, advocated in the workplace, and emphasized during medical training. However, even with proper hand washing, there still may be a problem. According to a study conducted by Dr. Charles Gerba, a microbiologist with the University of Arizona, there can be unsafe levels of harmful bacteria, coliforms, and other illness-causing microorganisms in the soaps and lotions typically found in the workplace. Taking swab samples from more than 100 open, refillable soap dispensers, Gerba found that approximately 25 percent of the samples contained evidence of bacterial contamination.

Gerba reported that the bacteria were often in "overwhelming numbers" and capable of causing serious infections. Further, he indicated that the infections the bacteria could cause ranged from eye and skin irritations to very serious health problems.

The contamination appeared most frequently in warmer, indoor environments, including showers and sinks located in locker rooms and large restroom areas. Notably, it was found only in the open, refill-type soap dispensers, which require the fresh soap to be poured into an existing dispensing unit. There was no contamination in factory-sealed soap-dispensing systems.

Neither Gerba nor his researchers could determine an exact reason why only the refillable dispensers were contaminated and the factory-sealed cartridge systems were not. It could be because the refillable systems are exposed to airborne contaminants, the cleaning worker touches the soap in the refilling process, or bacteria develop while the bulk soap is in storage after opening. Whatever the reason, building managers are encouraged to select factory-sealed soap cartridges and dispensers.

Clean Hands Yes, But What About the Environment?
There is one further consideration regarding proper hand washing and the use of contamination-free soaps, and that is the impact of hand soaps on the environment. "Today there are several environmentally preferable hand soaps available," said Stephen Ashkin, the professional cleaning industry's "father of Green Cleaning" and president of The Ashkin Group and Sustainable Tool, LLC. "And, as for cost and effectiveness, there is little difference between environmentally preferable [hand] soaps and conventional soaps."

As with all green products, an environmentally preferable hand soap is one that has a reduced impact on human health and the environment when compared to comparable products used for the same or similar purpose. However, Ashkin explained there are a few critical issues managers and occupational safety experts need to consider.

"First, the hand soaps selected should not have added antimicrobial ingredients (e.g., Triclosan) except as required by code or regulation," he said. "This is because there is little evidence that these soaps actually provide greater health protection, and Triclosan is classified as a pesticide. It has been linked to liver damage and can negatively impact the environment."

Ashkin also advised selecting soaps that have no fragrances or dyes because they can potentially irritate users' skin. "Also, the green soap selected should remove the types of soils the user will most likely encounter," he added. "For example, if working in an industrial facility, soap should have a better degreasing capability than one intended for office use."

Hand Sanitizers
Information on proper hand hygiene would not be complete without a discussion of hand sanitizers. Hand sanitizers should always be viewed as an interim measure to supplement proper hand washing. Sanitizers can kill germs and bacteria; however, they are not intended to clean hands.

To help protect the environment, Ashkin suggested not selecting conventional alcohol-based sanitizers, but instead choosing a waterless hand sanitizer with alcohol derived from biobased resources, typically corn-derived ethanol. He also advised placing hand sanitizers throughout a facility -— at elevator doors, in food service areas, in breakrooms, and in office cubicles, as well as outside restrooms. "People are so concerned about touching doorknobs or push plates," he said. "Placing the hand sanitizer directly outside restrooms is a simple and reassuring way to keep hands clean and healthy."

How to Properly Wash Hands

• Remove any rings or other jewelry.
• Use warm water and wet your hands thoroughly.
• Use soap (1-3 mL) and lather well.
• Scrub your hands, between your fingers, up to your wrists and forearms with soap for 20 seconds.
• Scrub under your nails.
• Rinse thoroughly.
• Turn off the taps/faucets with a paper towel.
• Dry your hands with a single use towel or air dryer.
• Protect your hands from touching dirty surfaces as you leave the bathroom.